Clinical Strategy 2016-2021 Stakeholder Engagement Findings Author: H Emmerson, Stakeholder Engagement Manager Great care, close to home
Executive Summary This report collates the findings of stakeholder engagement undertaken to inform development of the LCHS Clinical Strategy 2016-21. Activities included 2 stakeholder events, discussion with patient groups and a patient & public survey. Stakeholders were generally supportive of the key strategy objectives but identified key challenges and were keen to understand how LCHS would overcome these: Key Themes from Stakeholder Engagement Events: The focus should be on collaboration not competition. There is a need to break down barriers between organisations and ensure that care is integrated and delivered by the right person with the right skills and the right time in the right place. We need to work more effectively with the voluntary sector and develop volunteering within LCHS The patient needs to be viewed as an individual and steps should be taken to avoid people slipping through the net. We need to provide people with the tools and confidence to manage their own care. Patient information needs to be of a high standard - accurate, current, relevant and accessible. Real health and social care collaboration is essential together with clear pathways and understanding of responsibility and remit of care providers. A cross provider approach to recruitment and sharing of resources would be needed in order to develop a flexible responsive workforce and avoid duplication. Provision of an effective wraparound service would require the buy in of all commissioners and providers. Community hubs should be easily accessible. Technology and communication needs to be utilised effectively. Patient & Public Survey key results: Question Patient Client/ Customer Service User 1. As someone who uses health care services how would you prefer to be 75% 7% 13% described? (5% chose other ) Question Good Bad idea Not sure Idea 2. What is your view on having a range of health care services located 75% 5% 20% together in one accessible community hub? 3. Part of the LCHS strategy involves patients/carers having greater control 73% 4% 23% over their care and taking greater responsibility for their own condition in partnership and with the support of health professionals. What do you think about this? 4. LCHS is considering developing a Patient Charter summarising your rights 72% 12% 16% and responsibilities as well as what you can expect when you use LCHS services. What is your view on this? Question Yes No Maybe 5. There are a number of volunteering opportunities within LCHS and we are keen to increase these. Would you be interested in volunteering? 6. Would you be interested in participating in a focus group to progress any of the above topics or any aspect of our clinical strategy? 24% 38% 38% 21% 35% 44% Next Steps: This engagement has provided the Trust with valuable input, ideas and suggestions and also paved the way for improved partnership working and new collaborations. We will continue this important conversation with our stakeholders as we implement our strategy and align future engagement with county wide LHAC STP engagement activity. To facilitate this continuous engagement and co-production we anticipate establishing stakeholder action groups and the development of volunteering within the Trust. 1 P a g e
Background The Trusts Clinical Strategy 2016 2021 sets out our ideas for how we will provide clinical care over the next five years. Appendix 1 Clinical Strategy Summary Our vision is: We will provide personal care for people outside the large acute hospitals, as close to home as possible. We will make it easier for people to understand their condition and share in their treatment. We will help people to confidently do more for themselves and to know how to get the right help when needed. We will prevent problems wherever possible, and when things go wrong, make sure the right person provides what is needed promptly. We will work in partnership with other healthcare providers as well as the wider system including services for housing, education and employment. In order to inform the development of the strategy we have undertaken a number of engagement activities with a range of stakeholders. These included 2 events, attended by commissioners, health and social care providers, voluntary sector representatives, patients and members of the public, discussion with patient group representatives and circulation of a survey to gather views and suggestions from our membership and the wider community. Appendix 3 Attendance details Survey Findings: We used a simple survey to seek opinion on key elements of the strategy ( Co-location of services and selfcare) to gather views on the introduction of a patient charter and to gauge the appetite of members and the public to get more involved in implementation of the strategy. In addition we took the opportunity to talk to members about the terminology and accessibility of the strategy. Appendix 2 Patient and Public Survey Sensible to have services located together. Easier access for patients and would improve communication between different services It would depend on how many of these hubs there would be and where, as transport can be a problem Key Themes: If you wish to centre most of the services in Lincoln I have grave concerns. The services need to be in the far corners of the county 75% of respondents were supportive of the principle of co-location of services commenting on how this would be a better use of resources and potentially be more convenient for patients. Concerns were raised about the location of these hubs given the size and rurality of the country and queries raised about what provision would be made for those with transport issues. 2 P a g e
Will work for some. But other people need someone to take responsibility for their care I would always prefer to have control of my care but safeguards need to be in place for the vulnerable. Sounds to me like more dumping on GPs A lot of patients could do more to help their condition by taking more care of themselves Key Themes: 73% of respondents were supportive of the principal of self-care and recognised that the individual had a role to play in managing their own lifestyle and health and wellbeing. Comments were made in regard to the challenge this presented in terms of re-educating people and facilitating the necessary culture shift. Concerns were raised that there would be some patients who may struggle to manage their own health conditions and that there would need to be effective support mechanisms and robust measures to ensure that people do not slip through the net. Concern was also expressed that patients may become isolated. Key Themes: Over 70% of respondents felt that the introduction of a patient charter would be a positive step if the content was of value and clearly explained the rights and responsibility of both patient and care provider. Detractors suggested that a charter should not be necessary whilst others commented that it could be a waste of time and energy if it was not jointly developed and fully embraced by all parties. 3 P a g e Good idea - Everyone will then clearly know where responsibilities lie Please make sure this is something of substance and not just a form of words that allows LCHS to take no responsibility. If there's a charter, it must be worth something. Not sure one is needed. This should have been developed a long time ago.
If I can help in any way, just ask I really have no idea of the opportunities or services required and their suitability towards the capabilities of the volunteers Depends what opportunities are available No particular service, but thought needs to be given to people that would like to help but who work full time Key Themes: Over 60% of respondents stated that they may be interested in volunteering depending on the opportunities available. It was identified that there was very little information available about volunteering for LCHS. I am a pharmacist employed by ULHT working in a community hospital. I may not have a completely objective view, but have also concerns etc as a potential service user I d like to be involved in the Patient charter, patient participation or co location of services. Key Themes: If I can contribute remotely I would like to have input on co-location, self-care and improving Over 60% of respondents said they may be interested in participating in a focus group to progress implementation of the strategy. It was suggested there should be a variety of ways for interested parties to participate in this process, not just focus groups. 4 P a g e
Key Themes: The majority of respondents preferred the term patient to any of the other options provided. Engagement Event Feedback In order to generate constructive debate and discussion with our stakeholders the strategy team arranged 2 events which were attended by commissioners, health and social care providers, voluntary sector representatives, patients and members of the public. We also presented and discussed the clinical strategy with a number of patient group representatives. Appendix 3 Attendance details At the first event stakeholders worked in groups to consider the overarching themes below: How we organise services Role of the patient Workforce Where services are delivered A visual recorder was in attendance and created a visual representation of the strategy based on the discussion which took place and the LCHS vision of great care, close to home. Appendix 4 Clinical Strategy Visual Stakeholders were generally supportive of the key strategy objectives. Attendees identified key challenges and were keen to understand how LCHS would overcome these. Key Themes: 1. How we organise services: Themes - The focus should be on collaboration not competition. There is a need to break down barriers between organisations and ensure that care is integrated and delivered by the right person with the right skills and the right time in the right place. Questions - What is the role of the volunteer and the role of the voluntary sector in delivery of this care and how do we work more effectively with the third sector? 5 P a g e
2. Role of the patient: Themes - The patient needs to be viewed as an individual. We need to provide people with the tools and confidence to manage their own care. Patient information needs to be of a high standard - accurate, current, relevant and easily accessible. Questions - How do we ensure that people do not feel unsupported and that no one slips through the net? 3. Workforce: Themes - Clear pathways and clear understanding of responsibility and remit of care providers is essential. Cross provider approach to recruitment and sharing of resources is necessary to develop a flexible responsive workforce and avoid duplication. Questions - How do we enable real health and social care collaboration? 4. Where services are delivered: Themes - Provision of an effective wraparound service requires the buy in of all commissioners and providers. Community hubs should be easily accessible. Technology and communication needs to be utilised. Questions - How do we ensure equitable access to community services? The second event enabled stakeholders to participate in discussion around some of the specific service developments; Integrated Care Transitional Care Self-Care Specialist Children s Service Clinical Assessment Service (CAS) Working with Voluntary sector & Volunteering The views and suggestions of attendees have been themed for simplicity in the categories of benefits and challenges. Key Themes: 1. Integrated Care Benefits: Cross pollination of ideas pooling expertise Shared learning Reduces duplication Services being patient focussed rather than system focussed Improved continuity of care Reduces number of handoffs - more timely Proactive, preventative and responsive approach Different ways of working using technology Challenges: How do we support staff to work in rural localities? How will we ensure the service is equitable and avoid a postcode lottery? Need for robust governance, policy and procedures Rurality of Lincolnshire how will hubs work and where will they be located? Support will be needed for patients as we introduce new ways of workings One size doesn t fit all 6 P a g e
2. Transitional Care Benefits: Real opportunity to join all services up and work with voluntary sector particularly in the area of palliative care Patients will be receiving the right care in the right place Should reduce bed blocking Single point of access Challenges: More complex care packages take a long time to come through Are beds flexible enough? Dilemma of distant care. Carers assessments must be embedded within this pathway Carers should be supported to understand more about management of health conditions Out of hours support for people seen by EMAS 3. Self-Care Benefits: Patient is empowered Patient has more control and works together with health professionals Patient is seen as an individual - care plan specifically covering role of the patient Challenges: Need to identify what is important to the patient Need to re-educate and engage people in lifelong learning Need to understand family dynamics and be prepared to respond to life events Early identification of issues in order to plan proactively More structured approach is required to link in with, and build, health and social care networks There is a real need for carer support and respite Requires health promotion programme through many mainstream channels who will fund this? Is there potential to incentivise and reward behavioural change? 4. Specialist Children s Service Benefits: Service offers support with a varied skill mix of therapists Structured care pathways for parents Mobile service Within the services there is the ability to offer a range to all children to suit their needs Skills so that people can self-manage, less likely to need access to adult services in the future Based in the community - part of a child s life and the parent becomes the expert Offers a complete service for vulnerable children with health conditions Challenges: Commissioning decisions Children s specialist s nurses within the acute trust are bound by their policies. Occupational Therapists are not commissioned to see a large number of children Patterns / rates of referral tends to be geographical and in socio-deprived areas there is developmental delay in language, disability and lack of opportunity Wheelchair service it takes too long to get an appointment and this inhibits the therapy service 7 P a g e
5. Clinical Assessment Service (CAS) Benefits: Patient signposted / referred appropriately Right service, right person, right place and right time Better use of existing resources (e.g.) Ambulances Challenges: Managing anxiety and patient expectation Ensuring accurate, up to date and inclusive directory of service Patient interface managing bounce back Ensuring effective involvement of voluntary sector Developing alliances & facilitating onward referrals How will this work across regional boundaries and borders? 6. Working with Voluntary sector & Volunteering Benefits: Potential to build community capacity through voluntary sector infrastructure Health benefits for individual volunteer Evidenced quality improvements and improvement in patient satisfaction Volunteers / voluntary sector are often best place to provide certain types of care and support Challenges: How do we fit with what is already being provided by others organisations Need to develop a wide range of opportunities Will require resources - dedicated resource to manage, support volunteers, provide good training and supervision Finite pool of volunteers can we develop a joint resource? Conclusion & Next Steps This engagement has provided the trust with valuable input, ideas and suggestions and also paved the way for improved partnership working and new collaborations. Whilst stakeholders were broadly supportive of the key elements of the clinical strategy they identified potential challenges which the trust will address as it develops services and establishes new ways of working. We will continue this important conversation with our stakeholders as we implement our strategy and will align future engagement work with county wider LHAC / STP engagement activity. To facilitate this continuous engagement we will feedback the findings of engagement activity to date and continue to communicate with our stakeholders via a bi monthly stakeholder update. In order to adopt a real co-production approach as we work towards implementation we propose establishing working / focus groups which would include a range of stakeholder representatives. Stakeholder relationship management will continue to be a high priority with renewed focus on strengthening current relationships and building new relationships particularly within the voluntary sector and General Practice. More work will be done looking at potential volunteering opportunities within our services and consideration given to the practicalities of how we could manage and support volunteering within LCHS and in particular how we can involve our current membership of 12,000 public, patients and staff. To further inform our strategy, encourage ownership and increase understanding we will engage with our wider staff membership. 8 P a g e
Appendix 1: Clinical Strategy Summary LCHS Clinical Strategy 2016-21: Summary WHAT? This strategy document sets out our ideas for how we will provide clinical care over the next five years. The strategy fits with the wider picture of the way Government wants care to be delivered including looking at how health and care organisations can work together to improve outcomes for all patients. Our vision for the next five years is: We will provide personal care for people outside the large acute hospitals, as close to home as possible. We will make it easier for people to understand their condition and share in their treatment. We will help people to confidently do more for themselves and to know how to get the right help when needed. We will prevent problems wherever possible, and when things go wrong, make sure the right person provides what is needed promptly. We will work in partnership with other healthcare providers as well as the wider system including services for housing, education and employment. WHY? Our many employees have been providing care in the community for decades. We have the expertise, training and well established systems to ensure the best quality of care in localities all over the county. We have four community hospitals and numerous other bases from which to provide cross cover, mutual support and to learn from each other. We have knowledge of the needs of Lincolnshire people and neighbouring areas, and excellent contacts with the larger hospitals and other Trusts and carers to cooperate when this is needed. We already work well the wider system including services for housing, education and employment. All of this means that we have the knowledge to guide us towards newer, progressive models of care that will provide better care for its people. WHERE? We will deliver care that is: As close to home as possible. In community hubs, where possible, bringing many services together. In community hospitals when intensive rehabilitation or urgent care is needed or sometimes for care at the end of life. We will use schools, community pharmacies, and other sites wherever this makes sense. We will move towards 24/7 services, using more technology and working through a centralised Operations Centre. Our Urgent Care Centres will support this by working through the 111 phone line and the Clinical Assessment Service. WHO? These plans are for patients throughout their lifetime, for carers and families, and for our staff; they are for those who will be working in partnership with us and for those who will commission our services. The team that will deliver this will: Be increasingly multi-professional and multi skilled, including generic practitioners, specialist staff, and therapy staff. Be able to rotate between teams and services and across Trust boundaries. Work with volunteers to a greater extent and make sure patients are fully involved in prevention and treatment. 9 P a g e
HOW? At all times we will involve patients, carers and their communities when planning or delivering services. This engagement will influence our care of the frail elderly, those with long term conditions and children with complex needs. It will improve the way we work with the large acute hospitals and with the commissioners. At all times we will listen to our staff and foster a culture of compassionate care. Together, we will ensure patients: Understand their condition better and are clearer about their longer term care plan via a Patient Charter. Are more in charge of their treatment where this is practical and involved in decision making at all times. Are better connected by technology to those providing care. We will organise services with greater simplicity, avoiding red tape. We will: Strive for simplicity, and rely heavily on evidence based practice. Allow for more variation to meet different needs in different places when needed. Be more efficient in the way time is spent with the patient, and will use group-based intervention when this works. Improve the efficiency of procurement and of the provision of care. Use technology to allow staff to work away from their base, access records, and to make notes, to prescribe and to communicate, to allow patients to be more in charge of their condition and fully informed, and to make clinical observations more easily in the home. We will need teamwork between nurses, social care, voluntary services, GPs, and all types of specialists regardless of who they work for. Our staffing plans will be guided by the services we provide. This will mean detailed workforce planning including: Greater flexibility and clearer definition of roles with more rotation between teams and across Trust boundaries. Novel approaches to recruitment including apprenticeships. Greater efficiency in the use of time and better supervision. SO WHAT? We will measure ourselves against the five domains of the Care Quality Commission, striving to improve our rating from Good to Outstanding. This will be overseen through a framework of performance management, concentrating on outcomes. The quality of what we do will be measured against a wellresearched framework from the King s Fund, an independent charity working to improve health and care in England. Our strategy will be supported by service plans, clear objectives, carefully chosen metrics and comparison with other providers doing similar work. To read the full strategy document please click here 10 P a g e
Appendix 2: Patient and Public Survey http://www.smartsurvey.co.uk/s/stzhb/ As someone who uses health care services how would you prefer to be described? 1 Patient 2 Service User 3 Client 4 Customer 5 Other (please specify): What is your view on having a range of health care services located together in one accessible community hub? 1 Good idea 2 Bad idea 3 Not sure Part of the LCHS strategy involves patients/carers having greater control over their care and taking greater responsibility for their own condition in partnership and with the support of health professionals. What do you think about this? 1 Good idea 2 Bad idea 3 Not sure LCHS is considering developing a Patient Charter summarising your rights and responsibilities as well as what you can expect when you use LCHS services. What is your view on this? 1 Good idea 2 Bad idea 3 Not sure There are a number of volunteering opportunities within the Trust and we are keen to increase these. Would you be interested in volunteering within Lincolnshire Community Health Services? 1 Yes 2 No 3 Maybe Would you be interested in participating in a focus group to progress any of the above topics or any aspect of our clinical strategy? 11 P a g e 1 Yes 2 No 3 Maybe
LCHS believes that providing accessible information will help improve access to services, promote social inclusion and enable people to make more informed choices about their care. How would you prefer to be contacted? 1 Letter 2 Email 3 Text 4 Other (please specify): Would you like information in an alternative format? 1 Audio 2 Braille 3 British Sign Language 4 Easy read 5 Large print 6 Alternative community language (please state) If you have any further comments or queries about our clinical strategy please share these here. 1 Open-Ended Question Appendix 3 Event Attendance Lists Attendance Event 2.pdf Attendance Event 1.pdf 15122016_Patient Council_draft minutes 12 P a g e
Appendix 4: Clinical Strategy Visual